Ding Kexin, Chen Hui, Wang Yong, Liu Hongmei, Zhang Wenzhong, Wu Yiqun
Department of Epidemiology and Biostatistics, School of Public Health, Peking University.
Department of Internet Management and Quality Control, Beijing Emergency Medical Center.
Eur J Emerg Med. 2023 Apr 1;30(2):125-131. doi: 10.1097/MEJ.0000000000001004. Epub 2023 Jan 30.
Activation of emergency medical services (EMS) is recommended for timely reperfusion therapy for acute ischemic stroke (AIS). The association of EMS utilization and time intervals from hospital arrival to a series of necessary procedures before reperfusion therapy was rarely investigated.
The objective of this study is to investigate the association of EMS utilization with the time intervals from hospital arrival to therapy in patients with AIS.
Observational study.
Medical records for AIS in all emergency departments in Beijing were obtained from January 2018 to December 2021.
Patients transported by ambulance were defined as the EMS group, whereas others as the non-EMS group.
Door-to-imaging time (DIT), door-to-needle time (DTN) and door-to-puncture time (DTP) were compared between the two groups.
There were 11 190 (46%) and 13 106 (54%) AIS patients in the EMS and non-EMS groups. Compared with the non-EMS group, patients in the EMS group were more likely to receive intravenous thrombolysis or endovascular therapy (OR, 1.81; 95% CI, 1.68-1.94). For intravenous thrombolysis therapy, the DIT, ITN (time in minutes from obtaining the first brain imaging to tPA delivery) and DTN times in the EMS group were significantly shorter with time differences between the two groups of -1.1 (95% CI, -1.1 to -1.1) min, -2.6 (-2.6 to -2.6) min, and -3.7 (-3.8, -3.7) min, respectively. The proportion of DIT ≤25 min, DTN ≤45 min or DTN ≤60 min was significantly higher in the EMS group (OR, 1.03, 95% CI, 1.02-1.05; 1.11, 1.07-1.14; 1.05, 1.03-1.07). For endovascular therapy, the differences in DIT, ITP (time in minutes from obtaining the first brain imaging to groin puncture) and DTP times between the EMS and non-EMS groups were +1.1 (1.0-1.2) min, -3.8 (-4.2 to -3.5) min, -2.7 (-3.1 to -2.4) min, respectively, but no significant association was observed between EMS usage and the proportion of DIT ≤25 min or DTP ≤90 min.
In this observational study, the use of EMS for patient with AIS was associated with a shorter time from hospital arrival to intravenous thrombolysis and endovascular therapy.
对于急性缺血性卒中（AIS），推荐启动紧急医疗服务（EMS）以进行及时的再灌注治疗。EMS的使用与从医院到达至再灌注治疗前一系列必要程序的时间间隔之间的关联鲜有研究。
本研究旨在调查AIS患者中EMS的使用与从医院到达至治疗的时间间隔之间的关联。
观察性研究。
获取了2018年1月至2021年12月北京所有急诊科中AIS的医疗记录。
通过救护车转运的患者被定义为EMS组，而其他患者为非EMS组。
比较了两组之间的门到影像时间（DIT）、门到针时间（DTN）和门到穿刺时间（DTP）。
EMS组和非EMS组分别有11190例（46%）和13106例（54%）AIS患者。与非EMS组相比，EMS组患者更有可能接受静脉溶栓或血管内治疗（OR，1.81；95%CI，1.68 - 1.94）。对于静脉溶栓治疗，EMS组的DIT、ITN（从获得首次脑部影像到静脉注射组织型纤溶酶原激活剂的时间，单位为分钟）和DTN时间显著更短，两组之间的时间差异分别为 - 1.1（95%CI， - 1.1至 - 1.1）分钟、 - 2.6（ - 2.6至 - 2.6）分钟和 - 3.7（ - 3.8， - 3.7）分钟。EMS组中DIT≤25分钟、DTN≤45分钟或DTN≤60分钟的比例显著更高（OR，1.03，95%CI，1.02 - 1.05；1.11，1.07 - 1.14；1.05，1.03 - 1.07）。对于血管内治疗，EMS组和非EMS组之间的DIT、ITP（从获得首次脑部影像到腹股沟穿刺的时间，单位为分钟）和DTP时间差异分别为 + 1.1（1.0 - 1.2）分钟、 - 3.8（ - 4.2至 - 3.5）分钟、 - 2.7（ - 3.1至 - 2.4）分钟，但未观察到EMS使用与DIT≤25分钟或DTP≤90分钟的比例之间存在显著关联。
在这项观察性研究中，AIS患者使用EMS与从医院到达至静脉溶栓和血管内治疗的时间缩短相关。
